Gliederung

Objective: Intraoperative MRI (iMRI) and neuronavigation are established adjuncts to the treatment of various neurosurgical disorders. In no patient population has the extent of the surgical resection been shown to be more important than in pediatric patients. Intuitively the benefits of iMRI appear to be their greatest in this setting. The authors summarize their experience in the pediatric population using an intraoperative high-ﬁeld iMRI a 1.5T with integrated neuronavigation.

Methods: Twenty consecutive cases were treated between January 2009 and November 2011 consisting of diverse neoplastic and non-neoplastic intracranial pathologies. A total of 22 intracranial neurosurgical procedures were performed in 20 children (9 male and 11 female). Focussing on whether intraoperative imaging and neuronavigation affected surgical strategy the entire surgical procedure was evaluated for feasibility, image quality, accuracy and safety.

Results: The median age at surgery was 10 years (3–20 years).Treated lesions included pilocytic astrocytomas, anaplastic astrocytoma, medulloblastomas, ependymoma, adenoma, ganglioglioma, hamartoma, cortical dysplasia, inflammatory lesions and gliosis. Neuronavigation was applied in all cases with high accuracy. The importance of iMRI was apparent in the 16 procedures to resect neoplastic lesions leading to further surgical resection in 50% of the cases. Thus gross total resection was achieved in 13 surgeries. iMRI during 6 procedures for the treatment of non-neoplastic disease did not lead to any change in surgery but conﬁrmed the surgical goal of the surgeon. Average image quality was excellent. Permanent morbidity was 9%, whereas mortality was 0%.

Conclusions: High-ﬁeld iMRI in pediatric neurosurgery is safe and allows to perform less invasive surgical exposures. Its potential is greatest when its high image quality is coupled with its superior neuronavigation capabilities, which permits tracking of the extent of resection of intracranial tumors and, to a lesser extent, other lesions during the surgical procedure.